Septate uterus with cervical duplication and longitudinal vaginal septum: a report of five new cases

OBJECTIVE: To describe a unique congenital müllerian anomaly. DESIGN: Case report. SETTING: A university-based reproductive endocrine center. PATIENT(S): Five reproductive-age, nulligravida patients who underwent clinical, radiologic, and surgical work-up. INTERVENTION(S): Retrospective review of prior medical records and studies. MAIN OUTCOME MEASURE(S): Definition of abnormal pelvic anatomy. RESULT(S): Five patients from a university-based, reproductive endocrine center were found to have cervical duplication with a longitudinal vaginal septum, uterine septum, and a normal fundus. The patients most often presented initially to their primary obstetrician-gynecologists with symptomatic complaints secondary to their vaginal septums. Diagnoses were obtained with physical examinations, ultrasound imaging, hysterosalpingograms, magnetic resonance imaging, and surgical evaluation. CONCLUSION(S): These findings call into question the classic hypothesis of unidirectional (caudal to cranial) müllerian development and supports an alternative embryologic hypothesis of Müller et al., which states that fusion and resorption begins at the isthmus and proceeds simultaneously in both the cranial and caudad directions. The high number of cases reported here might be due to the increased accessibility and accuracy of such imaging modalities as magnetic resonance imaging. These patients will be followed longitudinally so that it can be determined whether this anomaly affects fertility and so that the optimal treatment plans can be developed.     

Adenomyosis within a uterine septum in a patient with secondary infertility

Abstract

Background: Adenomyosis is a benign infiltration of endometrial stroma and glands into the myometrium. Until the advent and advancement of imaging techniques such as transvaginal ultrasound scan (TVUS) and magnetic resonance imaging (MRI), the diagnosis of adenomyosis could only be made with confidence using histology following hysterectomy.

Case: The patient is a 37-year-old woman, with a long history of secondary infertility. A hysterosalpingogram (HSG) and a pelvic MRI showed two separate uterine cavities. The patient underwent laparoscopy and hysteroscopy revealing a bicornuate appearance of the uterus and a uterine septum. Resection of the septum showed adenomyosis on histologic examination.

Comment: Adenomyosis of uterine septum should be considered if MRI shows features of adenomyosis elsewhere in the uterus with thickened junctional zone. Further research is needed to investigate this association with the pathogenesis of adenomyosis.     

Primary adenocarcinoma arising from endometriosis of the rectovaginal septum: a case report

Adenocarcinomas developing in endometriotic lesions have been reported, most commonly in the ovary. The rectovaginal septum is a rare location of this neoplastic transformation. We report a case of primary adenocarcinoma arising from endometriosis of the rectovaginal septum in a 25-year-old woman presenting with lower abdominal pain and dyspareunia. Diagnostic and treatment modalities were discussed. Immunohistochemical studies of different keratin subtypes and CA125 expression of the tumor cells are of interest for the diagnosis. Preoperative radiation therapy promotes clinical symptoms relief, tumor volume reduction, and better radical surgical approach.     

Reproductive outcome following resectoscope metroplasty in women having a complete uterine septum with double cervix and vagina

Objective

To evaluate reproductive outcomes in women with complete uterine septum with double cervix and vagina following resectoscope metroplasty.

Methods

The pregnancy outcomes of 21 women who underwent vaginal and uterine septum resection were compared with those of 15 untreated women with similar clinical characteristics. The Fisher exact test and the Mann-Whitney test were used for statistical analysis.

Results

Cycle fecundity was better (33.4% ± 28.5% vs 12.2% ± 4.7%; P = 0.046), the rate of term delivery significantly increased (P < 0.05), and the rate of spontaneous abortion decreased (P < 0.05) in the treatment group.

Conclusion

Resectoscope metroplasty was found to improve the pregnancy outcomes of women having primary infertility or a history of pregnancy loss associated with a complete uterine septum with double cervix and vagina.     

A Rare Uterine Malformation: Asymmetric Septate Uterus

Study Objective

To demonstrate a step by step surgical hysteroscopy technique in a patient with asymmetric uterine septum and transverse uterine septum that was not previously described in the literature.

Uterus didelphys: a report of 26 cases

Twenty-six female patients with uterus didelphys were observed over a period of 21 yr. All the patients also had a longitudinal vaginal septum. Dysmenorrhea, dyspareunia and leukorrhea were the most common symptoms among the symptomatic cases. Eighteen women had a total of 40 pregnancies with a fetal survival rate of 67.5%, and perinatal mortality rate of 3.6%. Premature delivery occurred in 21% of the pregnancies. Breech presentation occurred in 43% and cesarean section was performed in 82% of the cases. Of the 17 intravenous pyelograms performed six (35%) showed abnormalities and four had the absence of a kidney. Women with uterus didelphys belong to a high-risk group, although pregnancy outcome is comparatively good.     

Mucocolpos due to complete transverse septum in middle third of vagina in a 17-year-old girl

A 17-year-old girl had a large abdominopelvic mass (12 x 8cm) extending from vagina, due to the presence of a complete transverse vaginal septum in its middle third which on resection facilitated the drainage and disappearance of the mass finally diagnosed as a case of mucocolpos.     

Laparoscopic Colpo-Pneumo Occluder as a Vaginal Mold for Vaginal Reconstruction

BackgroundCurrently, there is no commercially available soft vaginal mold designed for reconstructive surgeries for congenital vaginal anomalies. Stricter operating room regulations discourage the use of makeshift molds from foams and gloves. A colpo-pneumo-occluder balloon is designed to maintain pneumoperitoneum after colpotomy in laparoscopic hysterectomies and is approved for use in vaginal surgeries.CaseA 17-year-old girl with a congenital transverse vaginal septum experienced recurrent obstruction and hematocolpos. We successfully used a colpo-pneumo-occluder balloon as a vaginal mold during postoperative care. Its size and design make this device ideal for use in vaginal reconstructive surgeries in adolescents.Summary and ConclusionThe laparoscopic colpo-pneumo-occluder, a sterile vaginal device, is appropriate to use as an adjustable, soft vaginal mold for correction of congenital and acquired vaginal anomalies.     

Resectoscopic treatment of complete longitudinal vaginal septum.

Every gynecologist can easily recognize vaginal abnormalities and the subsequent disturbances of sexual function, such as dyspareunia and apareunia, arising from them. In the case of congenital vaginal septum, it is extremely important to completely assess the abnormality before planning for surgical treatment. Because normal vaginal development is subsequent to the canalization and fusion of the two Müllerian ducts once vacuolization has occurred, but not their union, a duplication of different degree will be the consequence. If the defect is complete, a didelphys uterus with a double vagina will result. The aim of our report is to describe the endoscopic technique used to treat three cases of complete longitudinal vaginal septum and to highlight the main differences between our technique and the standard surgical procedure.     

阴道直肠隔子宫内膜异位症25例的诊断治疗

目的 :探讨阴道直肠隔子宫内膜异位症的诊断和治疗方法。方法 :回顾分析1986至 2 0 0 2年手术病理证实的阴道直肠隔子宫内膜异位症 2 5例。结果 :发病年龄平均39岁 ,临床表现为各种形式的盆腔痛及不育 ,6 6 .7%合并有肠道症状。病灶位于阴道直肠隔内 ,单发 2 0例 ,多发 5例 ,直径 1～ 4cm。术前药物治疗中假孕疗法 7例 ,4例症状缓解 ,3例无效 ;假绝经疗法 8例 ,6例症状缓解 ,2例无效。 2 3例行手术治疗 ,2例行病灶切除术 ,11例行全子宫及阴道直肠隔异位病灶切除术 ;3例行全子宫单侧附件及阴道直肠隔异位病灶切除术 ;7例行全子宫双附件及阴道直肠隔异位病灶切除术。术后 6例用药物治疗 ,3例假孕疗法 ,3例假绝经疗法。在平均 15 .2月的随诊中 ,2 0例 (80 % )症状缓解 ,5例 (2 0 % )复发 ,其中 4例于术后 1年内复发 ,多发灶位于阴道直肠隔 ,1例于术后 14月复发 ,多发灶位于阴道残端。根治性手术组 (全子宫双附件及阴道直肠隔异位病灶切除术 )无 1例复发 ,非根治手术组 5例复发 ,两组差异有显著性 (P <0 .0 1)。结论 :阴道直肠隔子宫内膜异位症临床少见 ,通常有盆腔痛及不育 ,肠道症状的发生率高。临床诊断依靠妇科三合诊 ,药物治疗可以短期缓解症状 ,根据年龄、症状、生育要求采取个体化的手术治疗是主要的     

Septate uterus with cervical duplication: a full-term delivery after resection of a vaginal septum

We report a full-term delivery after resection of a longitudinal vaginal septum in a patient with a septate uterus and cervical duplication.     

Determinants of fertility and reproductive success after hysteroscopic septoplasty for women with unexplained primary infertility: a prospective analysis of 88 cases

Objective

To evaluate prospectively the effect of hysteroscopic septoplasty as therapy for unexplained primary infertility in women with uterine septum as a sole cause for reproductive failure and to define the factors influencing reproductive success.

Study design

In a prospective comparative study, we enrolled 103 infertile women with uterine septum as a sole cause for reproductive failure. They had had unexplained primary infertility >2 years and a follow-up >12 months. Uterine anomalies were diagnosed by means of hysterosalpingography (HSG) and 2D-transvaginal sonography (TVS) with intrauterine saline infusion. Hysteroscopic septoplasty was performed in the early follicular phase. Pregnancy rates (PR) according to patient and septum characteristics (septum size) were the main outcome measures.

Results

Follow-up was complete for 88 patients. The mean (±SD) age of the patients was 36.1 ± 2.1 years. Forty-two patients became pregnant (40.7%). The mean (±SD) delay in conception was 7.5 ± 2.6 months. Nearly 80% of the pregnant women conceived spontaneously. Of 44 pregnancies in 42 women, 36 live newborns were delivered. The PR was significantly higher in women <35 years of age or with <3 years of unexplained primary infertility. Moreover, in women with a septum size larger than one-half of their uterine length the PR was significantly higher than those with septum size <1/2 of their uterus (P = .12).

Conclusion

Fertility and pregnancy after hysteroscopic septoplasty in women with unexplained primary infertility and uterine septum as a sole cause for reproductive failure seems to depend on patient age, duration of infertility before septoplasty, and septum size. Women with a septum size larger than one-half of their uterine length have a higher chance of successful pregnancy after hysteroscopic septoplasty.